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Ventricular enlargement in MS

One-year change at various stages of disease

From the Institute of Neurology (C.M.D., D.H.M.), London, UK; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London, UK; St. Michael’s Hospital (P.W.O.), Toronto, Canada; Moorfields Eye Hospital (G.T.P.), London, UK; and University of Western Ontario (G.P.A.R.), London, Ontario, Canada.

Address correspondence and reprint requests to Dr. Professor D.H. Miller, NMR Research Group, Institute of Neurology, Queen Square, London WC1N 3BG, UK; e-mail: d.miller{at}ion.ucl.ac.uk

Objectives: To investigate ventricular enlargement (VE) over 1 year at three different stages of multiple sclerosis (MS).

Methods: A semi-automated technique for measuring VE was applied to MRI scans in 26 patients with clinically isolated syndromes (CIS) suggestive of MS, 30 with early relapse-onset MS of 1 year duration, 41 with established relapsing remitting (RR) MS, and 23 with secondary progressive (SP) MS.

Results: VE at 1 year was seen in early MS (median increase 0.3 mL [p = 0.003]), RRMS (median increase 0.5 mL [p = 0.001]), and SPMS (median increase 1.1 mL [p = 0.001]). Allowing for age there was more VE in the SPMS group (p = 0.005). No VE was observed in the CIS only group (median decrease –0.001 mL [p = 0.829]). Significant increases in T2 and T1 hypointense lesion load volume were seen in all MS subgroups: there were no differences between the groups in T2 volume increase but there was a larger increase in T1 hypointense lesion volume in the SPMS group compared with early RRMS.

Conclusions: Ventricular enlargement is a sensitive measure of progressive cerebral atrophy that is seen at all stages of multiple sclerosis (MS) and is more marked in secondary progressive than relapsing remitting MS.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 14 issue to find the title link for this article.

Disclosure: Elan Biogen consented to the use of placebo arm data from one of their clinical trials to be included in this study. Elan Biogen had no role in the design and analysis of this study, or in the preparation and approval of the manuscript. Drs. Dalton, O’Connor, and Miller have received grants from Elan Biogen. Drs. Dalton, O’Connor, Rice, and Miller have received honoraria from Elan Biogen. Dr. Dalton received salary support from Elan through a grant held by the Institute of Neurology to analyze MRI data from the placebo arm of the International Natalizumab Multiple Sclerosis Trial Group.

Received June 20, 2005. Accepted in final form November 17, 2005.

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